Colorectal cancer (CRC) and diabetes mellitus are two common diseases that frequently occur together and may share underlying genetic, metabolic, and immune-related mechanisms. Previous studies have shown that diabetes is associated with an increased risk of colorectal cancer and poorer clinical outcomes, while colorectal cancer itself may also influence glucose metabolism. This prospective observational study aims to investigate the relationships among glucose homeostasis, shared genetic factors, inflammatory responses, immune cell profiles, and colorectal cancer outcomes. Participants with colorectal cancer and non-colorectal cancer controls will undergo serial assessments of glucose-related biomarkers, inflammatory markers, immune cell populations, and genetic analyses over time. The study will focus on identifying shared genetic variants that may contribute to both colorectal cancer and diabetes-related traits, as well as exploring biological pathways involving inflammation, immune regulation, and metabolism. Blood samples and available colorectal tissue specimens will be analyzed to evaluate gene expression, immune cell distribution, and molecular changes associated with disease progression. The results of this study may improve understanding of the biological links between colorectal cancer and diabetes, facilitate the development of personalized risk assessment strategies, and identify potential biomarkers and therapeutic targets for patients with colorectal cancer.
Colorectal cancer (CRC) and diabetes mellitus (DM) are major public health challenges worldwide. Epidemiological studies have demonstrated a bidirectional association between these two diseases, suggesting the existence of shared biological mechanisms involving glucose regulation, inflammation, immunity, and genetic susceptibility. However, the genetic and molecular pathways linking CRC and abnormal glucose homeostasis remain incompletely understood. Recent genomic studies have identified several candidate pleiotropic genes that may influence both glycemic traits and CRC risk. Among these candidates, SMAD7 has emerged as a potential shared genetic factor involved in glucose homeostasis, inflammatory signaling, immune regulation, and colorectal tumorigenesis. SMAD7 participates in the TGF-β and NF-κB signaling pathways and may influence interactions between metabolic dysregulation, chronic inflammation, and cancer progression. The present study is designed to investigate the genetic, molecular, metabolic, and immunological relationships between CRC and glucose homeostasis abnormalities. Large-scale genomic resources and clinical data will be integrated to identify and validate shared genetic variants associated with both conditions. In addition, a prospective observational cohort will be established to evaluate longitudinal changes in glucose metabolism, inflammatory biomarkers, immune cell profiles, and gene expression patterns in patients with CRC. Particular emphasis will be placed on the characterization of systemic and tumor-associated immune responses, including cytotoxic T lymphocytes and regulatory T cells, and their relationships with glucose homeostasis and candidate genetic variants. Blood samples and available colorectal tissue specimens will be analyzed using molecular, genomic, and immunologic approaches to explore potential mechanisms linking metabolic abnormalities and colorectal cancer progression. By integrating genetic discovery with clinical and biological investigations, this study aims to improve understanding of the shared pathways between CRC and diabetes-related traits, identify biomarkers associated with disease progression, and provide a foundation for future precision medicine strategies in colorectal cancer.
Study Type
OBSERVATIONAL
Enrollment
200
Association between shared genetic variants and glucose homeostasis biomarkers
Concentrations of fasting plasma glucose (mg/dL), hemoglobin A1c (%), fasting insulin (μIU/mL), and C-peptide (ng/mL) will be measured at baseline and during follow-up. Associations between identified shared genetic variants (e.g., SMAD7) and glucose homeostasis biomarkers will be assessed using regression analyses.
Time frame: Baseline to Week 48
Incidence of colorectal cancer-related outcomes
Occurrence of colorectal cancer-related outcomes, including recurrence, progression, or mortality, during the follow-up period. Event rates (%) and time-to-event outcomes will be recorded and analyzed according to genetic variant status.
Time frame: Baseline to Week 48
Expression level of SMAD7 in systemic blood and colorectal tissue
SMAD7 expression levels will be measured in systemic blood and local colorectal tissue samples using quantitative polymerase chain reaction (qPCR) or RNA sequencing. Expression levels will be reported as relative expression values, normalized gene expression counts, or fold change across predefined exposure groups.
Time frame: Baseline to Week 48
Concentrations of inflammatory and immunological biomarkers in systemic blood and colorectal tissue
Inflammatory and immunological biomarkers will be measured in systemic blood and local colorectal tissue samples using enzyme-linked immunosorbent assay, multiplex cytokine assay, immunohistochemistry, flow cytometry, or transcriptomic profiling, as applicable. Outcomes will include biomarker concentrations, staining scores, immune cell proportions, or normalized expression values across predefined exposure groups.
Time frame: Baseline to Week 48
Proportions of T cell subpopulations in systemic blood and colorectal tissue
T cell subpopulations, including cytotoxic T cells, regulatory T cells, helper T cells, and other relevant T cell subsets, will be measured in systemic blood and local colorectal tissue samples using flow cytometry, immunohistochemistry, or single-cell RNA sequencing, as applicable. Outcomes will be reported as percentages of total lymphocytes, percentages of CD3+ T cells, cell counts, staining scores, or normalized cell abundance estimates.
Time frame: Baseline to Week 48
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